Emotion regulation skills-focused interventions for chronic pain: A systematic review and meta-analysis

Nell Norman-Nott; Negin Hesam-Shariati; Michael A Wewege; Rodrigo R N Rizzo; Aidan G Cashin; Chelsey R Wilks; Yann Quidé; James H McAuley; Sylvia M Gustin

doi:10.1002/ejp.2268

Emotion regulation skills-focused interventions for chronic pain: A systematic review and meta-analysis

Eur J Pain. 2024 Apr 1. doi: 10.1002/ejp.2268. Online ahead of print.

Authors

Nell Norman-Nott^{1

2}, Negin Hesam-Shariati^{1

2}, Michael A Wewege^{2

3}, Rodrigo R N Rizzo^{2

3}, Aidan G Cashin^{2

3}, Chelsey R Wilks⁴, Yann Quidé^{1

2}, James H McAuley^{2

3}, Sylvia M Gustin^{1

2}

Affiliations

¹ NeuroRecovery Research Hub, School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia.
² Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.
³ School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Department of Psychological Science, University of Missouri-St Louis, St. Louis, Missouri, USA.

PMID: 38558425
DOI: 10.1002/ejp.2268

Abstract

Objectives: To investigate the effect of emotion regulation skills-focused (ERSF) interventions to reduce pain intensity and improve psychological outcomes for people with chronic pain and to narratively report on safety and intervention compliance.

Methods: Six databases and four registries were searched for randomized controlled trials (RCTs) up to 29 April 2022. Risk of bias was evaluated using the Cochrane RoB 2.0 tool, and certainty of evidence was assessed according to the Grading, Assessment, Development and Evaluation (GRADE). Meta-analyses for eight studies (902 participants) assessed pain intensity (primary outcome), emotion regulation, affect, symptoms of depression and anxiety, and pain interference (secondary outcomes), at two time points when available, post-intervention (closest to intervention end) and follow-up (the first measurement after the post-intervention assessment).

Results: Compared to TAU, pain intensity improved post-intervention (weighted mean difference [WMD] = -10.86; 95% confidence interval [CI] [-17.55, -2.56]) and at follow-up (WMD = -11.38; 95% CI [-13.55, -9.21]). Emotion regulation improved post-intervention (standard mean difference [SMD] = 0.57; 95% CI [0.14, 1.01]), and depressive symptoms improved at follow-up (SMD = -0.45; 95% CI [-0.66, -0.24]). Compared to active comparators, anxiety symptoms improved favouring the comparator post-intervention (SMD = 0.10; 95% CI [0.03, 0.18]), and compared to CBT, pain interference improved post-intervention (SMD = -0.37; 95% CI [-0.69, -0.04]). Certainty of evidence ranged from very low to moderate.

Significance: The findings provide evidence that ERSF interventions reduce pain intensity for people with chronic pain compared to usual treatment. These interventions are at least as beneficial to reduce pain intensity as the current gold standard psychological intervention, CBT. However, the limited number of studies and certainty of evidence mean further high-quality RCTs are warranted. Additionally, further research is needed to identify whether ERSF interventions may be more beneficial for specific chronic pain conditions.

Publication types

Review